The incorporated aortomitral homograft for double-valve endocarditis: the ‘hemi-Commando’ procedure. Early and mid-term outcomes†

Elgharably, Haytham; Hakim, Ali H.; Unai, Shinya; Hussain, Syed T.; Shrestha, Nabin K.; Gordon, Steven M.; Rodriguez, L. Leonardo; Gillinov, A. Marc; Svensson, Lars; Navia, José L.

doi:10.1093/ejcts/ezx439

Cited by 32 publications

(47 citation statements)

References 19 publications

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“…In Dr. David's series of 90 patients with double valve IE, the incidence of postoperative pulmonary complications was 24% with associated mortality 9% . In two different reports of invasive IE published by our group, respiratory insufficiency incidence was 39% and 65% …”

Section: Discussionmentioning

confidence: 90%

“…[9][10][11] Coplex valvular IE that involves the intravalvular fibrosa, or a perivalvular abscess requires aggressive debridement, complex reconstruction, and a prolonged procedure to eradicate the biofilm-associated infection. 9 In Dr. David's series of 90 patients with double valve IE, the incidence of postoperative pulmonary complications was 24% with associated mortality 9%. 10 In two different reports of invasive IE published by our group, respiratory insufficiency incidence was 39% and 65%.…”

Section: Discussionmentioning

confidence: 99%

“…10 In two different reports of invasive IE published by our group, respiratory insufficiency incidence was 39% and 65%. 9,11 Intraoperative use of inhaled pulmonary vasodilators has been described, and showed to improve cardiac output and decrease Intraoperative ventilation while on cardiopulmonary bypass has also been described and shown lead to lower levels of postoperative lung water, less pulmonary inflammation, quicker time to extubation. [6][7][8]12 To our knowledge, this is the first study to describe the elective application of both iEpo with continuous intraoperative low tidal volume ventilation while on CPB during surgery for complex cases of valvular IE.…”

Section: Discussionmentioning

confidence: 99%

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Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery

et al. 2019

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Background and Aim To compare outcomes of patients treated with inhaled epoprostenol and low tidal volume ventilation during cardiopulmonary bypass with those who did not receive this medication in the operating room at all, and those who received it as a rescue therapy at the end of the case. Methods Retrospective chart review between 2014 and 2017, follow‐up included the entire hospital stay. Results Seventy‐one patients were included, and mean age was 54 years. 78.9% of the patients were male. Procedures included 96% (n = 68) aortic valve replacement, 28% (n = 20) reconstruction of the intravalvular fibrosa, and 13% (n = 9) repair of an endocarditis‐related intracardiac fistula. Patients who received epoprostenol (iEpo) (treatment and rescue groups), when compared with the control group had more intra‐aortic balloon pump placement (23% vs 2.5%, P = .018), open chest after surgery (32% vs 7.5%, P = .012), and duration of mechanical ventilation (8.3 ± 2.7 vs. 2.4 ± 0.4 days, P = 0.01). There was no significant difference between the two groups in terms of extracorporeal circulatory support (6.5% vs 2.5%, P = .577) and hospital death (13% vs 10%, P = .72). In a subanalysis, hospital death and duration of mechanical ventilation were higher in the recue group when compared with the treatment group (P = .004 and .056, respectively). Conclusions Prophylactic application of iEpo with low tidal volume ventilation for an anticipated complex endocarditis operation may contribute to favorable outcome when compared with postoperative epoprostenol rescue.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery

et al. 2019

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“…This procedure is performed rarely and long-term data are not available. The only publication dealing with mid-term results involves 37 patients operated on between 2010 and 2017 in Cleveland Clinic (4). In-hospital mortality was 8% and 1-and 3-year survival was 91% and 82%, respectively (only one death was due to recurrent IE).…”

Section: Commentsmentioning

confidence: 99%

Multiple valve endocarditis: a Hemi-Commando procedure

Vojacek¹,

Žáček²,

Ondrášek³

2019

Ann. Cardiothorac. Surg.

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“…In such situations, a more aggressive approach is sometimes required. The reconstruction of the fibrous skeleton through the so-called "Hemi-Commando" or "Commando" operations represent a radical option that entails double valve replacement (44,45) .…”

Section: The Aortic Valve and Rootmentioning

confidence: 99%

Surgical Aspects of Infective Endocarditis with Focus on the Aortic Root

Cuevas¹,

Savić²,

Quintana³

et al. 2018

ejcm

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Infective endocarditis is an uncommon disease carrying a mortality between 10% and 25%. The mitral and aortic valves are involved between 34-42% and 36-50% respectively. Early and aggressive treatment is mandatory, this impacts on early and long-term outcomes. A multi-disciplinary team approach is currently accepted as standard of practice. Approximately half of the patients require cardiac surgery as a part of the treatment. In case of extravalvular spread of infection, persistent sepsis, multiple embolic events despite appropriate antibiotic therapy, acute or worsening conduction abnormalities or heart failure, urgent surgery must be considered. When the infection involves the aortic root, a radical approach is preferred. As we expected, prosthetic valve endocarditis has worst outcomes, particularly related to the higher mortality in reoperations.

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The incorporated aortomitral homograft for double-valve endocarditis: the ‘hemi-Commando’ procedure. Early and mid-term outcomes†

Cited by 32 publications

References 19 publications

Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery

Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery

Multiple valve endocarditis: a Hemi-Commando procedure

Surgical Aspects of Infective Endocarditis with Focus on the Aortic Root

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